Provider Demographics
NPI:1801896428
Name:WOLFORD, JERALD F (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:F
Last Name:WOLFORD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21272 HIGHLAND RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:VA
Mailing Address - Zip Code:20130-1754
Mailing Address - Country:US
Mailing Address - Phone:540-592-3767
Mailing Address - Fax:540-592-3767
Practice Address - Street 1:21272 HIGHLAND RIDGE LN
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:VA
Practice Address - Zip Code:20130-1754
Practice Address - Country:US
Practice Address - Phone:540-592-3767
Practice Address - Fax:540-592-3767
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32916207ZP0102X
MDD0074457207ZP0102X
VA0101247112207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988746Medicaid
NC88746OtherBCBSNC
NC213948Medicare ID - Type Unspecified
NC88746OtherBCBSNC